Provider Demographics
NPI:1043450547
Name:HOLMES, HENRY
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7852 AMERICANA CIR
Mailing Address - Street 2:APT 101
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7880
Mailing Address - Country:US
Mailing Address - Phone:443-597-8589
Mailing Address - Fax:
Practice Address - Street 1:7852 AMERICANA CIR
Practice Address - Street 2:APT 101
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7880
Practice Address - Country:US
Practice Address - Phone:443-597-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0019246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant